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The KISS Concept (Kinematic Imbalance due to Sub-occipital Strain)

The KISS concept was devised to incorporate the diverse symptoms I saw and treated in small children. The leading symptom is a fixed posture, sometimes a fixed lateral flexion, sometimes more a fixed retroflexion in combination with hypersensitivity of the upper neck area. For practical reasons it is useful to distinguish between KISS I (mainly fixed lateroflexion) and KISS II (primarily fixed retroflexion). Fig 4, Fig 5 give an overview of the findings found in these 2 models.

Fig 4.

KISS I clinical markers. Fixed lateroflexion: torticollis, unilateral microsomia, asymmetry of the skull, C-scoliosis of neck and trunk, asymmetry of gluteal area, asymmetry of motion of the limbs, retardation of motor development of one side.

Having treated children and infants for a number of years I was confronted with indications and therapies. Screening the relevant literature resulted in a large collection of publications, which were grouped around standard diagnoses and the various techniques of manual therapy/chiropractic/osteopathy used to treat them1, 2. Children belong to a “special population,” as the homonymous book implicates,78 but to assess the impact of functional disorders of vertebrogenic origin on the neuromotor development one has to integrate all these separate findings into a broader concept.

In many instances the techniques and indications of manual therapy are similar in children and in adults. The older children and adolescents become, the more their clinical picture is in line with what we know about adults. There are some differences in peripheral functional problems, but the bottom line is the same, such that, a local functional disorder with only limited, albeit sometimes strong, symptoms.

The “pulled elbow” (Chassaignac subluxation) of small children is such an example. A sudden pull at the extended arm of a toddler can result in a subluxation of the proximal head of the radius, which is trapped under the ligament annulare. The child’s arm hangs as if paralyzed and is not used. A simple adjustment is in most cases sufficient to revert this situation. This problem is child-specific, but does not have any impact beyond the local immobilization of the arm.

Other functional vertebrogenic disorders in small children are of different character. The effects of a local problem are felt far from their area of origin and may last much longer. The KISS concept does not intend to cover all instances of treatable spinal disorders, but to highlight those with a long-term harmful potential. This is important as many problems where children profit from an adjustment have unclear symptoms. Infantile headache, attention deficit disorder, or sensorimotor problems may be caused by a multitude of etiologic factors. To focus our efforts on children who may benefit from manual therapy, it is helpful to compare the individual case history with what is compiled as typical for KISS.

Fixed lateroflexion may be a trigger for pediatricians to ask for help from a manual therapy specialist. Other symptoms may be more important for the family, but these are less obviously connected to a functional vertebrogenic problem. Colic, for example, may be caused by KISS-related problems but pediatricians, midwives, and lactation consultants can only direct the families toward a specialist in MTC if they are aware of this possibility.

In many cases the 2 types of KISS overlap. One has to take into account that it is easier for a pediatrician to recognize the laterally fixed posture as pathological; however, the fixed retroflexion has to be actively searched for. Often it is best seen in the sleeping position of children (Fig 6, Fig 7). Initially I did not attribute much attention to this posturing. It was only after the parents reported spontaneously that their children slept much calmer and in a markedly more relaxed position that I became aware of the diagnostic importance of a fixed retroflexion of the head.

Fig 6.

A posture of fixed lateroflexion of KISS I. The left arm will be used more; therefore, the motor capabilities of this arm will be more advanced compared with the right arm. Often this asymmetry extends to the lower extremities and lead to an asymmetry of the gluteal furrows, which may be the first symptom observed by the pediatrician.

Fig 7.

The overextended sleeping position of KISS II. These children may have an orofacial hypotonia, which leads to sucking and swallowing problems. If these symptoms are combined with a fixed lateroflexion, these difficulties may lead to unilateral breast-feeding problems.

Through the observations of parents I then thought to check systematically if and how much I was able to relieve the pain of “crybabies” (ie, colic). Initially quite a few of these children were referred for the treatment of postural asymmetries and the accompanying colic was not mentioned by the parents during our interviews. In the questionnaire the parents are asked to return 6 weeks after their visit and they mentioned that the infants were much calmer and slept better.